Ricola USA | Promo BillBack Request

RICOLA PROMO BILLBACK REQUEST

Broker Name:

Account Contact:

Customer Name:

Buys Direct? Yes No

Promotion Date(s):
	Start:
	End:

Total Cost: $
Estimate? Yes No

Activities: Rebates / Billback on open stock Billback on Shippers Retail Ads / Circulars TPR	Reset / Planogram Secondary Placement Slotting Spiff New Store Openings Wholesale Shows Free Goods Markdowns Other
General Comments:

Distributor Name
Deducted By:		Issue Check?	Yes No
Make Payable To:		Date Submitted:
Address:

Rebates / Billbacks	Item(s)	Allowance Per Piece	Allowance Per Case
	Other:	$	$

Billback on Shippers	Billback/Shipper	Approx # of Shippers	Est. Total
	$		$

Retail Ads / Circulators	Flat Fee	Item(s)
	$	Other:

TPR	Item(s)	Allowance Per Piece	Allowance Per Case
	Other:	$	$

Reset / Planogram	Item(s)	Cost Per Item	# of Items	Total
	Other:	$		$

Secondary Placement	Item(s)	Other

Slotting	Item(s)	Cost Per Item	# of Items	Total
	Other:	$		$

New Store Openings	Fee Per Store	# of Stores	Total
	$		$

Wholsale Shows	Flat Fee
	$

Free Goods	Details

Markdowns	Item(s)	Allowance Per Piece	Allowance Per Case
	Other:	$	$

Other	Decription

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